Reflections on Medicine: Exploring the Human Side of Becoming a Doctor

For most medical students, the path to becoming a physician poses a host of challenges that are rarely covered in the classroom. They range from the practical to the philosophical: finding the right mentor, dealing with difficult patients, coping with the realities of a healthcare system that may fall short of one's ideals, confronting death for the first time, and more. This deeper dimension of medical education is often referred to as the "hidden curriculum."

Through Reflections on Medicine, students meet every six weeks to discuss emotionally laden issues related to their medical studiesEinstein is known for providing medical training that is both innovative and humanistic. Following in that tradition, Peter Kahn, class of 2016, and classmate Andrew Telzak created Reflections on Medicine (RoM), a peer-driven discussion group that offers medical students a forum for airing their innermost thoughts and feelings about the process that will transform them from medical students into highly-skilled and caring medical professionals.

Seeking a Safe Haven

Before coming to Einstein, Mr. Kahn was an honors student who majored in biology and philosophy at Yeshiva College and received his rabbinical ordination from Yeshiva's Rabbi Isaac Elchanan Theological Seminary. Accustomed to pondering ethical, moral and existential questions, he felt a need to connect with like-minded Einstein students and supportive mentors to explore these issues inherent in the practice of medicine.

Shortly after arriving at Einstein, Mr. Kahn attended an orientation session conducted by Dr. Paul Gross, assistant professor of family & social medicine, in which Dr. Gross had students form small groups and write essays describing their feelings about entering medical school. They were then invited to share their reflections with the group. Mr. Kahn was moved by Dr. Gross' presentation and asked to meet with him afterwards.

Later in his first year, Mr. Kahn enrolled in The Healer's Art, a month-long elective taught by Dr. Peter Selwyn, professor and chair of family & social medicine at Einstein and chair of the same department at Einstein's University Hospital, Montefiore Medical Center, as well as director of its office of community health. "Dr. Selwyn stressed the importance of embracing every patient's humanity as well as your own," recalled Mr. Kahn.

Established by medical student Peter Kahn (center), the group is typically attended by first- and second-year medical studentsHe received further support from Dr. Bruce Soloway, associate professor of clinical family & social medicine at Einstein and vice chair of the department at Montefiore. "As a guest speaker at one of our Reflections on Medicine sessions, Dr. Soloway shared his insights on working with real, live patients as opposed to cadavers," explained Mr. Kahn. "When I was shaping and refining my vision for the RoM program, I sought Dr. Soloway's advice and he was extremely helpful, offering practical suggestions for ways to approach the larger questions that group members might find troubling."

Mr. Kahn also found a kindred spirit in Mr. Talek. "We wanted to provide a location and a mechanism to talk and think about the emotionally laden issues facing us as medical students," said Mr. Kahn, "to pull back the curtain on the reality we were experiencing instead of having it ‘happen' to us."

Pulling Back the Curtain

In late spring 2013, the two friends launched Reflections on Medicine. Dr. Gross, who also is an attending physician in family & social medicine at Montefiore, agreed to serve as faculty advisor and mentor, with Mr. Kahn and Mr. Talek co-leading the first few sessions. Currently, the group meets every six weeks in the Board of Overseers Room, on the ground floor of Forchheimer. The 60- to 90-minute sessions draw, on average, about 10 first- and second-year students. As moderator, Mr. Kahn typically starts the session off with a quote to trigger the discussion. Dr. Gross, a frequent guest moderator and participant, encourages the students to think deeply and talk about their feelings regarding the issues that are on their minds. He also, on occasion, asks them to put down their thoughts in writing and to share their musings with the group.

A 1981 Einstein alumnus and editor of the online magazine Pulse: voices from the heart of medicine, Dr. Gross believes strongly in the power of reflective writing for helping students process what they've been seeing and how it makes them feel. He explained, "When students put their true emotions and reactions on paper, it helps them to not lose track of themselves as they go through medical training."

Members of the Reflections on Medicine leadership include (from left) Virginia Li, Zhenmei Zhang, Peter Kahn, Lindy Zhang and Joseph Gotesman"Reflections on Medicine provides an outlet through which we can contemplate the moral issues that can arise with the rapid changes occurring in medicine," noted Joseph Gotesman, Class of 2017, who studied philosophy and chemistry in college and has attended many RoM sessions. "For example, should anatomy involve the dissection of an actual dead person when you could use a computer-generated or synthetic model?"

"The discussions are truly open-ended. There's no expected outcome, no judgment" he added.

Growing the Program

Encouraged by RoM's initial success, Mr. Kahn set about drafting formal discussion modules and applied to the Arnold P. Gold Foundation, which promotes humanism in medicine, for a curriculum-development grant. The grant was funded in January 2014 and has allowed Mr. Kahn to expand the program's scope. He's in the process of developing additional modules and expects to have the full complement ready for the Class of 2018.

"Students will be able to use the modules to run their own discussion groups," he said. "Alternatively, the modules can be sponsored by Einstein, or by any medical school. Extracurricular resources will soon be available for download from the Reflections on Medicine website that is under construction, which can be slotted into the curriculum."

Passing the Torch

This fall, when Mr. Kahn pursues a master's degree in public health during a planned year of study outside of Einstein, he will have to cut back on his time commitment to RoM. But he has no worries. Mr. Gotesman, along with Zhenmei Zhang and Virginia Li, also members of the Class of 2017, will move the program forward.

"Reflections on Medicine has offered those of us who have participated in sessions an important outlet," noted Lindy Zhang, a third-year student who helped Mr. Kahn establish RoM and is now moving to clinical rotations on the hospital wards. "I hope that future RoM participants will learn, as I did, that it's important to open up about the uncomfortable feelings that come from doing certain things you have to do, like drawing blood. They're the feelings that make you human and allow you to have compassion for another human being."